We Remember

Q&A: CEO of the National Health Care for the Homeless Council Bobby Watts assesses past and future in homeless mortality

BY HANNAH HERNER

Thirty years ago, the National Coalition for the Homeless and the National Healthcare for the Homeless Council teamed up to put on the first National Homeless Memorial, held annually on December 21, the shortest day of each year.

But it’s not the sort of anniversary to celebrate.

“We should not be doing this 30 years later. We should have solved this problem by now, instead of it seeming to get worse,” says Bobby Watts, CEO of the National Health Care for the Homeless Council, which is based in Nashville.

The number of people dying from lack of housing-related causes is hard to fully know, because it’s rarely fully documented. Just a few days before the 30th National Homeless Memorial, NHCHC released a mortality toolkit to encourage cities to keep a standardized count of people who died while homeless.

Nashville’s homeless service providers team up to make the list as complete as possible each year, and while potentially underreported, the numbers certainly aren’t shrinking. In 2017 there were 117 deaths, 2018 had 127, there were 103 in 2019, and at time of press in 2020, there were 124 people who had died having experienced homelessness.

Watts evaluates the city’s work this year and looks at future priorities to help those numbers shrink in 2021.

How does Nashville fare nationally as far as addressing issues around homeless mortality?

From what I can see over the last year, they’ve really been trying to get more people housed. One of the silver linings of COVID is that there is CARES act funding to help people experiencing homelessness, and Nashville got a fair amount of funding. The Homelessness Planning Council said they wanted to put most of that into rapid rehousing, which is one of the things that we were in favor of.

Also Nashville, at least parts of it, are really looking at equity, looking at race equity in particular. Racism is a big driver of why we have homelessness presented as it does where people of color, especially African-Americans are overrepresented in the country. It’s not out of thin air, it’s out of historical patterns that continue to this day. They have formed an equity and diversity committee and I happened to be on it. It was a new committee formed in the last year. Another exciting thing in equity is [The Department of Housing and Urban Development] has [Continuums of Care] they’ve selected to be in a national demonstration project on equity, and Nashville is one of them. Nashville will get extra training and extra support in figuring out how to address equity when we’re responding to homelessness.

I saw one of NHCHC’s initiatives this year was medical respite. Can you tell me more about why you wanted to focus on that this year?

Medical respite is something that is so important, so lifesaving, for people who don’t have a home who no longer have a clinical reason to stay in a hospital. Without medical respite the hospital will discharge them back to a shelter or their friend’s couch or even the streets, not a safe place that’s equipped to help them heal. They will get sicker, come back into the emergency room with more complications, maybe need to be admitted back into the hospital. And of course, many cases never recover completely without a safe place to heal following the hospitalization.

If anything, the COVID pandemic has made the interest and the recognition of the need for medical respite greater than ever. So we created The National Institute for Medical Respite Care to help more communities develop medical respite.

What do you think are some of the biggest things people don’t understand around homeless mortality?

When it comes to homeless mortality people don’t connect the dots and see that homelessness kills. They know that it’s unfortunate. They know that it leads to human suffering. They may even know that it leads to poorer health. But they don’t really connect the dots that it leads to such great amounts of premature and excess deaths. The figure is, under 50 years of age average [life expectancy] for someone who’s on the streets versus 78 for the general population. So we’re losing about 30 years of life.

Looking toward 2021, what are some of NHC’s concerns and goals?

We’ve recognized that people need a safe place to live during a pandemic. The fact is people need a safe place to live period. So after the pandemic is over, will we continue that commitment?

Now we have two vaccines with emergency approval. Where in the priority list will people experiencing homelessness fall? We have recommended to the Centers for Disease Control and Prevention and to others that people experiencing homelessness should be high in the priority. And CDC has recommended that they are in phase two. So after frontline health workers and residents of nursing homes or longterm care facilities, people experiencing homelessness are in that second wave that includes prisons, jails and other congregate living situations.

So we’re pleased with that, but those are just guidelines. Each state will make its own vaccination plan.

If people are reading this and want to help, what’s a good thing for them to do?

I think probably even before supporting and learning is just caring. Often if you see someone experiencing homelessness and they may ask you for something, even if you can’t give, please just acknowledge the person, look them in the eye, say, ‘no, I’m sorry, not today,’ or something, but acknowledge and recognize their humanity and their dignity as a human being. That will often mean a great deal. So I would say that, then support, learn and advocate. When we’re talking about homelessness, mortality, people dying, it can be very technical. We’re talking about disease rates and death rates but it’s more than a technical issue. It is a moral issue.

For more information, visit NHCHC. ORG